Posts Tagged ‘Dr. James Sallis’

I was taking a delightful bike ride on a sunny but brisk December day in San Diego, and I actually passed a father and son who were riding electric bikes (no pedaling). Just a couple of minutes later I saw a family zipping around like robots on Segways. Those images kind of spoiled my ride—for two reasons.

First, instead of encouraging their kids to be active, these parents were promoting the easy joys of slothfulness. I’m sure they thought they were being good parents by having fun with their children, getting them outdoors, and introducing them to cool technology. Here we are, 10 years into the New Millenium, and teaching your child to avoid physical activity is still considered good parenting. With childhood obesity constantly in the media, why aren’t parents, as well as health professionals, public officials, school officials, and people in general, more concerned about making sure kids get enough physical activity?

That brings me to the second thought that spoiled my ride. The campaign to exterminate physical activity! Since the dawn of humanity people have been dreaming of ways to reduce their walking, get someone else to do the heavy work, and avoid sweating. For millennia it was pretty hard to avoid physical activity and stay alive. But in the past couple of hundred years, humanity’s dreams have come true. One of the main motivations of the Industrial Revolution was to supply people with the Labor Saving Devices they craved, and gazillions of dollars have been made in the process. Technological innovations have taken physical activity out of most work, transportation, and household tasks. Our homes and offices are filled with Labor Saving Devices, from the electric can opener to the computer to the car.

The extermination has taken about 200 years, but it is almost complete. Now, efforts to finally eradicate physical activity are getting a bit ridiculous. Is it so onerous to walk a quarter mile that you would pay $5000 for a Segway? Are people so committed to laziness that they will ride a bike that does the pedaling for them? Is there any longer a problem of too-much-activity that needs a solution?

What all this means is that we have a lot of work to do. Physical activity has been mainly exterminated, to catastrophic effect for our physical and mental health and medical costs. But still, people buy any gizmo that promises to squeeze the last few minutes of activity from their day. The Fitness Revolution of the 1980s did not create a culture of activity. Parents are not teaching their children to enjoy movement, dance, games, and sport as much as they need to. Appreciating new gizmos seems to take precedence.

Those of us who want to create better health through more activity continue to face big challenges. Looks like my resolution for 2011 will be to get a little better at encouraging people to enjoy being active.

I want to share an enjoyable moment with you. Recently, I was in Sacramento to film a discussion on physical activity promotion in schools organized by the California Department of Public Health’s Project LEAN. When the video is posted online, I’ll let you know.

While we were waiting in the “green room” before the filming I had inspiring conversations with my fellow panelists whom I had just met. A former teacher of the year who works in a small town was talking about his efforts to improve physical education in his new position at district manager of physical education, health, and sports. One of his goals was to use a common curriculum so students would benefit from a cohesive approach throughout their time in his district. He also wanted teachers in elementary and middle schools to communicate about physical education using the same terms and principles. I was pleased when he started talking about SPARK as his curriculum of choice. Beyond that, he saw SPARK as a partner in his efforts. He was enthusiastic about the support he received in planning his strategy, the quality of the training and the trainers, and that the curricula had consistent principles across levels applied in an age-appropriate way. He was really surprised when I told him I am a co-founder of SPARK. He thanked me for starting such a great program, and I thanked him for embracing SPARK.

The other panelist was a superintendent of a California school district. Though she was not a PE teacher, she was highly committed to coordinated school health and very familiar with SPARK. It was a treat to hear her impressions about SPARK and her appreciation for the efforts of the SPARK staff to support her efforts to improve the health of children in her district. She had seen SPARK benefit those students, who are largely low-income and Latino. Based on her experience, she recommends SPARK to others, and what could be more influential to school officials than a recommendation from a superintendent?

It was truly heart-warming to hear these unsolicited testimonials about SPARK. These school leaders did not know my connection with SPARK when they enthused about it, so I know it was totally genuine. This a good moment to thank the SPARK staff for their daily and nightly efforts to make physical education GREAT and to improve children’s health.

This week’s Blog entry features Dr. Sallis’ comments on the proposed changes to the Carol M. White PEP grant in response to:

Carol M. White Physical Education Program (PEP) Program Summary of Notice of proposed priorities, requirements, and definitions.
Published in the Federal Register, Vol. 75, No. 50; March 16, 2010

Thank you for the opportunity to comment on these proposed new directions for PEP grants. Physical education, physical activity, and public health professionals are grateful for the PEP grant program, as are parents and education officials. Physical education is the primary institution for preparing youth for a lifetime of physical activity, and PEP is the only federal funding for PE. PE also plays a role as a partial solution for childhood obesity, because it is the only the policy/program that can provide physical activity for potentially all students. Thus, there are many reasons for wanting the PEP grant program to be as effective as possible.

But there is not general consensus about the goals of PEP grants or how to achieve the goals. I am providing input as a psychologist and public health researcher who has been working to improve PE and youth PA for over 25 years. My priority is that PE should contribute to improving public health, and the surest way to accomplish this is to ensure students are active during PE. Certainly PE is more than physical activity, but almost everyone would agree that inactive PE is bad PE. PE has always been about “teaching through the physical,” but several studies show that students are inactive most of the time during PE. This is why PEP grants and other efforts to improve the quality of PE are needed. Most of the educational goals targeted in PEP grants can be accomplished better through activity, such as motor skills and social and emotional development.

The Public Health View of PE:

Let’s be clear that public health and PE professionals often have differing opinions about the goals of PE. As reflected in the PEP goals, PE professionals focus on preparing youth for a lifetime of activity, not on providing physical activity during PE. Public health professionals emphasize ensuring PE classes are active, because (a) PA provides well-document physical and mental health benefits during youth and (b) there is little or no evidence that PE has long-term effects on physical activity or health. Especially in the midst of the childhood obesity epidemic, it is a public health imperative to use every resource and opportunity to get children active, and PE is a high priority because it reaches more children than any other program or policy. Yet, students are mostly inactive during PE. Further, the PE profession has not embraced the goal of ensuring PE provides physical activity. My vision of the public health value of PE was written in this highly-cited paper 20 years ago.

Sallis, J.F., and McKenzie, T.L. (1991). Physical education’s role in public health. Research Quarterly for Exercise and Sport, 62, 124-137.

In short, there is little or no evidence linking proposed PEP goals/requirements with lifelong physical activity. There is much more certainty that getting children active NOW in PE classes leads to health and academic benefits. In fact, there is enough evidence to recommend active physical education as a strategy to improve academic achievement.

Thus, from the public health perspective, a critical missing emphasis in PEP is to increase moderate-to-vigorous physical activity (MVPA) in PE classes. Most studies show that students in PE are active less than 50% of the classes. Healthy People Objectives for the Nation (USDHHS) has included an objective since at least 1990 that PE should have at least 50% MVPA. http://www.healthypeople.gov/ However, such a goal is not endorsed by PEP or other Department of Education documents. I strongly recommend that the over-riding goal of PEP be changed. My recommendation is to require grants to improve MVPA in PE (all grants) and to undertake one or more of the other activities that may or may not promote physical activity. Inclusion of the other activities should be justified by the expected impact of the activity on child physical activity.

My recommendation is to explicitly encourage the use of evidence-based approaches and provide extra points for doing so. CDC’s Community Guide recommends enhanced (activity-oriented) PE as an evidence-based intervention. Thus, the current requirements are ignoring the health goals and evidence-based strategies for achieving them. Getting children active in PE provides immediate health and academic benefits and helps meet other goals of PE.

The broadening of PEP’s focus to require nutrition education would harm efforts to improve PA, PE, and fitness in youth. PEP funding has declined over the years and is currently very low. Thus, most of the schools applying are not funded. Of course, it is essential to improve children’s eating habits to improve health and prevent obesity. However, this is the wrong mechanism. These are reasons why broadening PEP to require instruction in nutrition is not a good idea:

By itself, nutrition education has modest to no effects on children’s eating. If the goal is to improve eating, then policy and environmental changes in schools are more promising. Targeting funding for nutrition education at the expense of evidence-based physical activity programs would have a net negative effect on children’s health.

Requiring every team to have expertise in both physical activity and nutrition would make it more difficult to put teams together.

Obesity control is generally dominated by nutrition interests and professionals. PEP is a unique source of federal funding for improving PE and physical activity programs in schools. There are already existing sources of funds for improving children’s eating habits.

The infrastructure (personnel, organizational structure, funding) for physical activity promotion is minimal in the US and is dwarfed by the nutrition infrastructure. See the references. Adding nutrition requirements to PEP would weaken the weak component (physical activity promotion) and strengthen the strong component (nutrition promotion).

Though I would be satisfied with restricting PEP funding to only improving the PE programs, there is also a rationale for allowing grants to support improved PE and other evidence-based physical activity strategies. There are other evidence-based approaches for promoting youth physical activity that could be included in multi-component programs, though they do not have as much evidence as enhanced PE. Numerous studies show that walking or biking to school contributes to higher overall physical activity, and Safe Routes to Schools programs have evidence of effectiveness.

After school time is the main opportunity for children to be active, yet low-income children have few physical activity resources like parks and programs in their neighborhoods. Thus, joint use agreements that allow schools to the community can provide nearby opportunities for daily physical activity targeted to children who need them most.

After school programs typically emphasize academics, but it is critical to provide physical activity during these programs. Physical activity guidelines for after school programs were developed using a rigorous evidence-based approach in California and could be a national model.

Proposed Requirement 1—Align Project Goals With Identified Needs Using the School Health Index

This is a reasonable requirement, and SHI is an excellent tool, but more flexibility in the choice of a needs assessment instrument could be helpful. For example, validated instruments like the YMCA’s Community Healthy Living Index, or a PE-specific evaluation could be justified. The PECAT has limited value since it only assesses the content of a curriculum, not the quality or quantity of its implementation.

Another option would be for the applicant to use the SOFIT method of systematic observation of PE classes to identify strengths and weaknesses of actual PE classes.

Proposed Requirement 4—Linkages With Federal, State, and Local Initiatives.

Requirements 2, 3, and 4 are redundant and would create an unnecessary burden on applicants. Many of the policies will be the same or overlapping, so it could be confusing to address all these different types of policies. One requirement that identifies the relevant policies and plans to improve policies and their implementation would be sufficient. The applicant should focus on (a) improving implementation of policies that cannot be changed or are sufficient and (b) improving policies that need change and are modifiable at the local level.

The PECAT is only an assessment of the PE curriculum. It does not deal with the implementation of a quality curriculum, which is also critical. This requirement should also provide encouragement for the adoption of curricula with evidence of effectiveness from research or evaluation.

Proposed Requirement 6—Equipment Purchases.

This approach to ensuring that equipment complements other program elements, including curriculum and training, is an important one.

Proposed Requirement 7—Increasing Transparency and Accountability.

Reporting requirements should be meaningful (directly related to program goals of getting students active) but minimal. There is a trade-off between extent of evaluation and program implementation, because time and resources are limited. The main goal is to use PEP resources to increase children’s physical activity. Though evaluating is critical, the goal is not to document every conceivable program outcome.

Pedometers: This is a useful and feasible tool for assessing PA. However, using them for overall daily PA should be the responsibility of the national evaluation team. PEP grantees should be responsible for evaluating the outcomes of their projects. If it is PE only, then using pedometers only in PE class would be the main goal. If the project targets PA throughout the school day, then using pedometers throughout the school day would be sufficient. Few school-based studies have documented physical activity changes outside of school.

3DPAR: I am co-author of a study showing that 3-day recalls are not valid in middle school students. Thus, there is little justification for the time that needs to be devoted to a 3-day recall. A 1-day recall is sufficient for an aggregate measure. I am also concerned this measure would not be sensitive to small changes since the reports are in 30-minute blocks. It would be better to pilot test this measure with a few grantees to determine feasibility and sensitivity to change.

Fitness tests: These would be fine at the beginning and end of each year.

Here is another approach to evaluating the impact of the PEP activities on student MVPA. This method could be used with any set of programs and could support cross-school comparisons.

1. Number of “opportunity minutes for physical activity” provided per enrolled child. These could be estimated over an entire school year and for by school and by specific programs, such as PE, recess, after school.

2. Estimated “physical activity minutes per child.” This value is based on multiplying the opportunity minutes with MVPA minutes per session of a sample of students engaged in the different programs using direct observation or pedometry.

Using these calculations would provide a simple metric that would allow all schools/PEP grants to be compared (i.e., on physical activity opportunity minutes per student per year AND observed/calculated physical activity minutes per year).

Because I am opposed to broadening PEP grants to include nutrition, I am opposed to requiring reports of fruit and vegetable consumption. If you decide to move ahead with measuring these outcomes, then consider this validated measure.

The evaluation criteria should be based on using the funds to maximize the impact on youth physical activity, sustainability of programs, and evaluation. Here are my recommendations for evaluation criteria for grants, and they should be communicated to applicants:

February 9, 2010. Write this down; make a mental note; consider it significant. This is the date that First Lady Michelle Obama announced her “Let’s Move” initiative to eliminate childhood obesity in a generation. It was all over the news. But you may have missed another announcement that is even more significant. The President appointed a Task Force on Childhood Obesity consisting of leaders of multiple federal departments and agencies. 2/9/10 is the day that all of our efforts to get kids active, fit, and healthy got a name, some celebrity, and some power.

This is a one-two punch of focus and power. The spotlight will now be strong. This is our best chance in a long time to make great progress on our shared vision of active healthy kids.

If, like me, you have been working for a long time to help children be active and healthy, we have been waiting for our concerns to be at the top of the national agenda. We can be proud that we have been on the right path and pursued a noble cause. But movement and change have been too slow. That is likely to change now. People in power want to listen to us now. They have joined our quest.

But progress will not be easy. Many Americans don’t think the country needs to change to provide more opportunities for kids to be active and to remove barriers to safe physical activity. Many people have a “just do it” mentality—it is a parent’s job to serve good food and tell the child to be active. But when good food is not in your neighborhood, no parks are in your neighborhood, traffic is too fast, and PE has been cut from the school day, what is a parent going to do? All Americans face barriers to being active, and it should be our goal to make it more convenient, safer, and more enjoyable to be active every day.

But the place to start is PE. This is the one program that can affect every child every day. PE needs to be active, and it needs to be taught by well-trained teachers. We know this works, and we can improve PE quickly. SPARK has been helping schools deliver activity-promoting PE for over 15 years. SPARK is ready and able to do more. Today, it was announced that the state of Florida received about $2 million to provide SPARK PE to every middle school in the state! One of the four goals of Let’s Move is to provide more opportunities for physical activity, and SPARK will help achieve it.

Our jobs are not finished. We cannot sit back and think the President and First Lady will make sure excellent PE is in every school; they will not eliminate childhood obesity on their own. We need to work harder, but our work is likely to have more of an effect now. It is up to us as educators, experts in PE and physical activity, parents, and members of our communities to support Let’s Move. We need to speak up. We need to keep information, good ideas, success stories, and good news about PE, physical activity, and solutions to childhood obesity visible in every communication channel all around the country. Please do your part. Sign on at http://www.letsmove.gov/ and send your thoughts to the First Lady.

Make 2/9/10 the day that you became a more vocal advocate for active healthy kids.